Self-Harm Report Calls for Compassion

Prominent British psychiatrists are calling for greater sensitivity on the issue of self-harm in young people. Such an approach could save lives, say experts in a recent report, “Managing self-harm in young people,” written by the Royal College of Psychiatrists for professionals working with young people, individuals, and their families.

It updates the College’s 1998 report on self-harm, and has been approved by the UK charity YoungMinds, the Royal College of Pediatrics and Child Health and the Royal College of Nursing. The authors recommend “courage and compassion in asking about self-harm from community to hospital settings.”

They also want to see a reduction of stigma and nonjudgmental and respectful treatment for young people who have self-harmed.

Further recommendations call for high-quality assessment at all levels of service, and for professionals to assess the young person’s digital life, such as social media use, as part of clinical assessments.

The experts do not believe that all 16- and 17-year-olds attending hospital due to a self-harming incident should be admitted, “but if there is any doubt about the safety of the young person, the arrangement, or the quality of assessment, then admission to hospital should follow.”

“Suicide remains the second most common cause of death among young people,” said Dr. Andrew Hill-Smith of the college. “Self-harm is an important signal of distress so it needs sensitive responses with careful handling. Our actions can make a difference for young people and turn lives around. Our actions can save lives.”

Co-author Dr. Max Davie added, “Self-harm is more common among young people than many realize. A survey of people aged 15 to 16 years carried out in the UK in 2002 estimated that more than 10 percent of girls and more than three percent of boys had self-harmed in the previous year.

“In most cases, people who self-harm do it to help them cope with unbearable and overwhelming emotional issues. These issues can lead to a buildup of intense feelings of anger, hopelessness, and self-hatred. Often it is not easy for someone to admit that they have a problem, let alone to confide in anyone about what they are doing.

“Therefore it is important health care professionals approach the subject with care and understanding. These guidelines will help tackle the stigma around the issues of self-harming, which can often put young people off seeking help and advice.”

Commenting on the report, Lucie Russell of YoungMinds said, “YoungMinds welcomes the publication and its vitally important recommendations. Self-harm is often dismissed as merely attention-seeking behavior but it’s a sign that young people are feeling terrible internal pain and are not coping.

“Young people today are growing up in a harsh environment with ever-increasing stress to perform at school, bullying both on- and offline, sexual pressures, and next to zero job prospects.

“The report rightly says that health care services must treat young people who self-harm with more dignity and compassion, but schools must also play their part in placing much more emphasis on teaching emotional resilience and coping skills, and mental health services must have the resources and capacity to respond to every young person who is experiencing extreme distress. Parents too should have places they can go and experts to talk to if their child is self-harming.

“We are also really pleased to see recognition in the report of the vitally important role digital technology plays in young people’s lives — both negatively and positively and how all clinicians must take account of this when assessing and treating young people who self-harm.”

John Carr, Senior Expert Adviser to the United Nations on internet safety and security, welcomed the report and the inclusion of advice on assessing Internet use. He said, “Young people’s lives in the year 2014 to a large degree are lived out and through the online media, through social networking sites, and so on. So it’s very important that health professionals understand that.”

In 2012, a handful of leading social media platforms came together to take action against pro-self-harm messages, as well as pro-anorexia. For example, Facebook officials said, “Facebook takes threats of self-harm very seriously. We remove any promotion or encouragement of eating disorders.”

A statement from Tumblr said, “We aim to sustain Tumblr as a place that facilitates awareness, support, and recovery, and to remove blogs that cross the line into active promotion or glorification of self-harm.”

However, these efforts are not always successful. Part of the problem is that if one avenue is blocked, another similar shortened or misspelled version appears and the same material is replicated there instead.